| Objectives1. Surveyed the continuity of acute leukemia cases from a three-A hospital toanalyze the conditions of nosocomial infection. Analyzed the related influencefactors such as the length of time, the chemotherapy types, the use ofantibacterial, ect. through single factor analysis，then inputted the related factorsinto the logistic regression to get the risk factors of the nosocomial infection.2.Through the case control studies to assess the clinical effect of strengthennursing measures which were pertinence, scientific and reasonable. The resultscould provide the basises for the department of infection management toformulate corresponding management measures. MethodsThis experiment is divided into two parts.PartⅠ: Prospective Study1) Designed questionnaire by reading literatures and seeking advice fromhemopathy experts according to the investigation purpose,. The questionnaireincludes basic material, the number of hospitalization times, the length of time,chemotherapy types and duration, the number of white blood cells andgranulocytes and drug use information, ect.2) Carried out an investigation to the patients of acute leukemia that be inhospital during2010.09-2011.03by the questionnaire. Totlly206cases whoaccepted chemotherapy in hospitalization time were selected. Inputted thecorrelation factor values into SPSS16.0to analyze the conditions and the riskfactors of the nosocomial infection.PartⅡ: Effect Evaluation1) The intensive care interventions were formulated by reading literatures andseeking advices from hemopathy experts. They were on the basis ofhaematology usual care measures and easily implemented and targeted.2) The experimental group was the patients with acute leukemia who wereadmitted to dwell in the three specific wards in hemopathy that we particularlyestablish where the patients were taken intensive care. The control group wasthe patients dwelled in the other wards that were taken hemopathy conventionalcares. There were no significant difference between the two groups of patients indiseases, age, gender, illness weight, treatment and other aspects, they wereselected completely randomly. 3) Formulated uniform questionnaire to detailedly record the patients’gender,age, chemotherapy types and duration, medication use information, whitegranulocyte number, and whether an infection happened and the site of infectionand pathogen, etc.4）Collected clinical cases of the two groups, contrasted the infection ratesand appraised the nursing efficacy.Results1. Patients with acute leukemia hospital infection rate was36.9%, during be inhospital patients have occurred on site infections, infection cases times rate was43.7%.2. The frequent nosocomial infection sites of acute leukemia was upperrespiratory tract infection（40%）, pulmonary infection（17%）and oral infection（17%）.3. The most commonly identified organisms was gram-negative bacteria (50%),while the gram-positive bacteria was accounted for32%,and the other identifiedorganisms was gungi(18%).4. Single factor analysis results showed that the significant risk factors includedthe length of time, the last days of chemotherapy, antibiotic use days, the useopportunity of G-CFS, the lowest number of white blood cells, the lowestnumber of neutrophils. This study showed that the longer length of the stay, thehigher rate the infection was. When the patients’length of stay less than10days,the infection rate was8.3%, the length more than20days, the infection rate was89%, while when the length of stay more than30days,12patients infected hada high infection rate of100%. The longer duration of the chemotherapy, thehigher the infection rate was, the duration more than7days had the infection rate 61.3%while the duration less than7days had the infection rate32.6%.Cumulative use days of antibiotic more than7days had the high incidence rateof94.3%, less than7days had the incidence rate of74.2%. Late use of G-CFS(neutrophils number<0.5×109/L) had a higher infection rate (82.6%) than earlyuse(neutrophils number>0.5×109/L)(42.3%). This study also found that WBCcount<1.0×109/L, the incidence of NI rate was76.7%,when theWBC>10.0×109/L, the incidence of NI was as high as100%, this group of8patients all had infection occurred. This study also showed that the smaller thenumber of neutrophils, the higher infection rate of NI was, when theANC>>1.5×109/L, the incidence of NI was18.1%, ANC<0.1×109/L, theincidence of NI was86.8%.5. There were3statistically significant variables in multivariate analysis, as thelength of time, antibiotics use days and the lowest number of neutrophils, theywere all the NI risk factors of the patients with acute leukemia.6. The infection rate of the experimental group which was implementedintensive care measures was19.0%, the control group was31.8%.These twoinfection rates had significant difference (χ2=5.930P=0.015).Conclusions1. The NI rate in patients with acute leukemia was high. The Patients often hadoccurred repeated and multiple sites of infection. We should take seriouslyattention to it.2. The main infection site of hospital infection with acute leukemia was upperrespiratory tract infection, pulmonary infection and oral infection; the mainpathogen was gram-negative bacterium. In the process of treatment and care, weshould pay special attention to early detection and early treatment. 3. The binary logistic regression showed that the length of time, antibiotics usedays and the numbers of neutrophils were the independent risk factors forpatients with acute leukemia. We can take active treatment and nursingintervention measures to reduce the incidence of nosocomial infection throughidentifying these high risk factors.4. The intensive care measure named a scientific, pertinence, operational nursingmeasure which was developed on the routine care measure and easily to beoperated. That was proved had the clinical value for controlling the infectionrate and should be popularization used. |
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